- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,311.31 / $8,709.64
| Facility | | $2,398.83 | $3,311.31 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,137.96 / $2,511.89 / $4,786.30
| Professional | | $2,137.96 | $2,511.89 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $3,801.89 / $3,801.89 / $5,495.41
| Facility | | $3,801.89 | $3,801.89 | $5,495.41 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,951.21 / $6,760.83
| Professional | | $1,995.26 | $2,951.21 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $2,344.23 / $3,162.28 / $5,248.07
| Professional | | $2,344.23 | $3,162.28 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,715.35 / $3,715.35 / $5,623.41
| Professional | | $3,715.35 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $2,398.83 / $3,019.95 / $4,786.30
| Facility | | $2,398.83 | $3,019.95 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $3,235.94 / $3,890.45 / $4,677.35
| Professional | | $3,235.94 | $3,890.45 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $4,677.35 / $11,748.98 / $19,498.45
| Facility | | $4,677.35 | $11,748.98 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,995.26 / $2,570.40 / $4,786.30
| Professional | | $1,995.26 | $2,570.40 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $16,982.44 / $16,982.44
| Facility | | $56.23 | $16,982.44 | $16,982.44 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $19,498.45 / $19,498.45 / $20,417.38
| Professional | | $19,498.45 | $19,498.45 | $20,417.38 |